Feeding sugar solutions to infants up to 12 months old helps reduce the pain of vaccinations, a systematic review showed.

Action Points

Explain to interested patients that this systematic review of randomized controlled trials showed that the benefits of using sweet solutions to ease the pain of minor medical procedures in newborns extend to older infants.

Feeding sugar solutions to infants up to 12 months old helps reduce the pain of vaccinations, a systematic review showed.

The effect appears to be weaker in older infants than newborns, Denise Harrison, RN, PhD, of Royal Children's Hospital in Melbourne, and colleagues reported online in Archives of Disease in Childhood.

Still, sucrose or glucose should be considered before and during injections, they said.

"Based on extensive evidence of the efficacy of sweet solutions in neonates and the evidence from this systematic review, sucrose or glucose along with other recommended physical or psychological pain reduction strategies, such as non-nutritive sucking, breast-feeding, or effective means of distraction, should be consistently utilized for immunization," they wrote.

"This information is important for healthcare professionals working with infants in both inpatient and outpatient settings, as sweet solutions are readily available, have a very short onset of time to analgesia, are inexpensive, and are easy to administer."

The efficacy of sugar solutions in reducing pain from minor procedures has been well-established for newborns, but the evidence wasn't as clear for infants older than 1 month.

To evaluate the evidence, Harrison and her colleagues performed a systematic review of 14 randomized controlled trials that included 1,674 total injections. Oral glucose or sucrose solutions were compared with water or no treatment.

Ten of the studies used sucrose solutions in concentrations ranging from 12% to 75%. A 30% glucose solution was used in another three studies. A final study evaluated two sucrose concentrations -- 25% and 50% -- and a 40% glucose solution compared with water.

Volumes were generally 2 mL or less, although one study used 10 mL of 25% sucrose.

In 13 of the 14 studies, sugar solutions of various concentrations administered during or after an immunization decreased crying incidence and duration, as well as composite pain scores. In the 14th study, a 12% sucrose solution was no better than sterile water.

Meta-analyses could be performed for three crying outcomes -- proportion, duration, and incidence.

In three studies, 50% sucrose or 40% glucose resulted in an average 10% reduction in the proportion of crying time compared with placebo (P=0.02).

In six studies, all but one using sucrose, there was a nonsignificant reduction of 16 seconds in crying duration with the sugar solutions. However, when two studies using 12% sucrose were excluded, the reduction became statistically significant (12 seconds, P=0.04), although the difference was clinically small, according to the researchers.

Finally, in three studies evaluating a 30% glucose solution, there was a 20% relative risk reduction in crying incidence (RR 0.80, 95% CI 0.69 to 0.93). Considering an absolute risk reduction of about 17% (from 80.6% to 63.8%), the number needed to treat was six (95% CI 3 to 20).

The optimal dose of sucrose or glucose could not be determined because of between-study variations in volumes and concentrations, according to Harrison and her colleagues.

"Although sucrose is the sweetest of the sugars . . . either sucrose or glucose could be used depending on availability and organizational preference as long as the solutions are sufficiently sweet (i.e., at least 30% glucose or 24% sucrose)," they wrote.

The authors acknowledged some limitations of the review, including the fact that variation across studies in the concentration of the sugar solutions, outcome measures, and timing of outcome assessment precluded inclusion of most of the studies in the meta-analyses.

Also, the researchers were not able to evaluate varying pain responses according to type of immunization, order of shots, or injection techniques.

Harrison was supported by The Pain in Child Health Strategic Training Initiative and the Canadian Institutes of Health Research (CIHR) Team Grant in Children's Pain. CIHR Knowledge Synthesis Grant Funding supported the systematic review.

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